fleet of Mercedes ambulances will need replacing and taking the opportunity to create a future-proof vehicle which might radically alter the way we view our vehicle.
A key point of design definitely centres on the Trusts commitment to reduce the overall weight of the ambulance to under 3.5 tons, to reduce running and fuel costs, and open up recruitment to the younger recruits who do not have a C1 licence which the current fleet requires. Environmentalists may view the down-sizing and footprint as being a positive move but there are other issues which need to be considered.
When the “concept” ambulance is type approved and appears on the front line, it will be made available for as many staff as possible to crew it, view it, inspect it and then access an online feedback forum where their comments and opinions can be recorded. This is most important because it will enable as many employees as reasonably practicable, to get hands on with the pre-production ambulance during its evaluation stage. It is most important that where members of staff have concerns, doubts, issues, ideas or displeasures, that they record their thoughts on the forum so that the Trust and the Vehicle Working Group can collate the feedback and make whatever changes that may be required before committing to the production of the new fleet.
The bodywork will be finished in traditional corporate colours and there is a transition from current blue lights to slimmer LED blue lights which will be strategically mounted to give all round warning, including “fend off” blue lights at the edge of the front number plate, to give advance warning when the vehicle is exiting from a blind junction.
Initial impressions are that the overall width and height are a lot less than the current Mercedes fleet of emergency ambulances and these is evidenced in how everything is being shoehorned into a vastly reduced box. For example, in the crew cab, the storage locker between the two seats is only just capable of accepting a half empty lunch bag. Due to the need to maintain access to the underfloor batteries, in front of it, the box cannot be made any longer, and the width is restricted by the seat arm rests and the seatbelt anchors. This was highlighted during the visit as being unacceptable because employees must be able to carry their food and drink in a cool locker away from the clinical working area. The idea of stacking the lunch bags, one on top of the other was rejected due to contents being squashed.
It was pointed out that if employees cannot safely and adequately carry their food with them, they will need to leave their meals in fridges back at their bases and returned there for their meals, which is how West Midlands Ambulance Service operates… this issue is currently being reviewed in order to satisfy Unison that staff foodstuffs can safely and adequately be stowed in the crew cab.
Minimalistic food stowage locker
It was also made clear that to future-proof the ambulance, we need to ensure that there is adequate storage of PPE as well as meal bags, for three (3) employees because it is commonplace now for an ambulance to have a third crew on board, either a student, observer or member of staff undergoing a return to work process.
Additionally, it was pointed out that road staff are regularly rostered to work over two meal times, such as 1000 - 2200 or 1100 – 2300 hours, so they would need to ensure that the midday and evening meals could be adequately stowed on board in a manner that would not be detrimental or degrade the foodstuffs being carried.
This is now being reviewed and the potential space above the windscreen is being investigated to see if a dedicated, cooled storage area can be created to accommodate the crew meal bags.
Reference to the reduction in overall size of the “concept” ambulance has already been made. Squeezing a gallon into a pint pot has always challenged mankind, and it does seem that the over-riding factor in this design is to focus on the pint pot and cram whatever is possible into it, rather than to list all the clinical, technical, consumable, replaceable and welfare essentials and source an appropriately sized container.
The design and configuration of the current and past fleet of ambulances ensured that the crew cab had stowage facilities for documentation, maps, food & drink, high viz jackets and a selection of disposable gloves. The diminutive cab interior does not allow for the positioning of four boxes of clinical gloves on the rear bulkhead; instead, the proposed location is two boxes side-mounted either side of the telemetry unit in front of the miniscule stowage locker.
The “concept” ambulance is currently on a Fiat Ducato base, which has much lower rear saloon floor level and a single large nearside sliding door. The ambulance is being fitted with a Ferno battery powered stretcher which the operator can raise or lower by simple up down buttons. The use of this type of stretcher removes the need for ramps or tail lifts, which in turn reduces the vehicle overall weight.
Guide wheels engage floor mounts, securing stretcher to ambulance.
Head end wheel unit raises. Weight taken by guide wheels and rear main wheels.
Stretcher moves forwards into rear saloon area, front wheels engage mounting.
Rear wheels raise, stretcher fully secure in this position before sliding fully forward.
The stretcher is easily controlled by one of two buttons and can be viewed on youtube.
The “concept” ambulance will have two different types of carry chair installed. A Ferno Track 2 will be mounted on the interior of nearside rear door of the patient saloon area while an Ezy Glide chair will be installed facing rearwards attached to the main bulkhead. This could double up as the attendants seat during airway management if required.
The Ferno Ezy Glide
The Ezy Glide is a powered tracked chair which has been in use with some PTS crews for 2 years and has received favourable comment. There is no actual physical lifting of patient with this chair as the track system powers the chair up and down the stairs or into the ambulance.
Of note: The Trust has previously agreed to arrange a thorough and proper assessment day by several members of staff including Unison Health and Safety, to evaluate and feedback on optional carry chairs currently available, including a risk assessment of the Ferno Track 2 carry chair. We are currently still waiting for the date, time and location for the assessment day to be announced, so that the chairs receive a robust assessment by end user staff.
The safety of employees and patient has been considered in the event of a rear end collision resulting on the vehicle ending up on its side. As a result, a roof mounted escape hatch will be installed so that if the rear doors and side sliding door are not usable, the occupants have an alternative emergency exit available.
The weight of the responder bags is greatly reduced by removing the oxygen cylinder and also creating separate Paediatric and Maternity grab bags which are not required to be taken to every patient on every call that is attended. This move should reduce the weight of the response bag from 13.5kg to under 10kg, and the Paediatric bag should weigh approximately 5kg.
The rear patient saloon area will be much easier to keep clean to a high IPC standard and there will be a tracking system on the offside wall for equipment to be easily and quickly removed or repositioned to suit changing needs on a job by job basis. Even the response, paediatric and maternity bags (which are lightweight cases) can be attached to the tracking.
The interior of the cases will be equipped with modular pouches which quickly removed, replaced and will make checking easier and hopefully prevent overloading. The number of Oxygen cylinders carried will be reduced including the provision of just one F size.
The two nearside attendant seats in the rear saloon will be required to meet current regulations. To achieve this, they will be installed facing forwards but will have the option to swivel inboard to a maximum of 45 degrees, in effect still facing forwards. The seats will be mounted on a track system so that the seats can be slid forwards or rearwards to allow the clinician to continue providing treatment and assessments whilst the vehicle is on the move.
The vehicle will be provided with alloy wheels to ensure better cooling for the brakes and the audible warning “Diesel Fuel Only” will be included to help prevent filling with the wrong fuel. There will be three clinical waste bins which will include (1) general waste (2) clinical waste and (3) infectious waste. There will be four 112 volt solar panels mounted on the roof to assist with I.T. management and also a Sat-Com dome mounted towards the rear of the roof. Communications technology should ensure that internet access is maintained at all times and a P.I.R mounted in the rear saloon ceiling to automatically activate the interior lights.
It is intended that a further visit to inspect the progress of the “concept” ambulance will be made in the very near future.